1. An evaluation of urgent medication supplies from a paediatric hospital pharmacy David Terry

2. David RP Terry Birmingham Children’s Hospital
An evaluation of urgent medication supplies from a paediatric hospital pharmacy at the request of parent-carers of children in primary care
RESCUE MEDICINES
David RP Terry
Birmingham Children’s Hospital
David RP Terry

3. Birmingham Children’s Hospital
220 beds
250 consultants
Secondary & Tertiary Care
c. 40% patients are taking continuing prescribed medication
NSF for children … standard 10 says .. Children should have access … to medicines … howver that access is sometimes compromised.
David RP Terry

4. Rescue Meds
Introduction
Medicines management across the interface may be problematic
Who prescribes – GP or Hospital
Dispensing by CP may be delayed
These problems may be enhanced due to unlicensed medicines so commonly used in paeditrics.
Little empirical data
BCH has embarked on service evaluation of these issues with the intention of identifying process changes that will improve seemless care.
David RP Terry

5. Rescue Meds Form David RP Terry
BCH is able to support patients by providing medicines at the direct request of the carer … a service we call Rescue Medicines.
To registered BCH patients who would be expected to obtain their medicines from a CP either via a GP or hospital Rx.
David RP Terry

6. Rescue Meds
Introduction
Objective: To evaluate the circumstances in which parent-carers of children in primary care request urgent medication supplies from BCH Pharmacy
David RP Terry

7. Method Survey tool developed 17 point 21st Nov 08 – 16th June 09
Rescue Meds
Method
Survey tool developed
17 point
21st Nov 08 – 16th June 09
Inclusion … if primary care route for medicines had failed (or was likely to fail)
Exclusion … if they should be getting meds dispensed from BCH
Ethics: Service evaluation
Free text coding by expert panel to consensus … Excel & SPSS
Developed by hosp & academic pharmacists, & techs & piloted with parent-carers.
Registered as a service evaluation audit
Patient identity was not requested nor obtained.
Survey offered during normal weekday opening
Two questions enabled free text answers and these were coded by expert panel
David RP Terry

8. David RP Terry

9. Results 25 surveys completed Patients from 10 PCTs and 22 GP practices
Rescue Meds
Results
25 surveys completed
Patients from 10 PCTs and 22 GP practices
76% (n=19) made special jouneys
50% took advice before attending
44% (n=11) had rescue meds before
2 respondents confirmed this was not a good time to complete the survey.
Average distance to BCH from patient’s postcode was 12.6miles – the longest = miles.
Usual CP was a mixture of large chain, small chain and independent chemists.
8 PCTs in the West Mids … 2 outside WM
Average time since last attendance at BCH = 17 days.
Advice from pharm n=6, doctor (GP+Hosp) n=5
Most patients who didn’t get advice before coming had had rescue meds before.
David RP Terry

10. Results 2 48% (n=12) Rx from Hospital 44% (n=11) Rx from GP
Rescue Meds
Results 2
48% (n=12) Rx from Hospital
44% (n=11) Rx from GP
1 in 3 say have difficulty getting meds ‘often’ or ‘very often’
28% (n=7) patients had missed doses
David RP Terry

11. Results 3 21 different medicines named Captopril most frequent
Rescue Meds
Results 3
21 different medicines named
Captopril most frequent
62% unlicensed
Most common reason coded as CP supply issue
Improve system by better CP procurement or better communication
David RP Terry

12. Rescue Meds
Conclusion
Paediatric patients in primary care use hospital services to obtain medicines when they encounter supply problems.
They do so for both licensed and unlicensed medicines and regardless of the origin of the prescription.
Whilst study was small problems identified 22 different GPs, 10 different PCTs and at least 18 CPs … indicating widespread problems.
This preliminary study is to continue and at present we now have over 65 questionnaire completed and an article for peer review is being prepared.
Improve system by better CP procurement or better communication
David RP Terry

13. Want to know more? www.access2medicines.co.uk
Rescue Meds
Want to know more?
Many thanks to the staff at BCH Pharmacy
Whilst study was small problems identified 22 different GPs, 10 different PCTs and at least 18 CPs … indicating widespread problems.
This preliminary study is to continue and at present we now have over 65 questionnaire completed and an article for peer review is being prepared.
David RP Terry